In the busy world of hospital medicine, where doctors and nurses find themselves rushed off their feet for most of the day, time to sit down and actually listen to patients is at a premium. Every doctor knows that our primary focus has to be on the most important aspects of the history and clinical examination in order to get to …
5 things patients say that should make doctors sit up and listen
I admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance of Walmart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see is …
Raising minimum wage directly impacts health
I’m an old school general surgeon. I graduated from med school in 1974 and after a five-year surgical residency in San Antonio, Texas, I started out on my own, ready to cure the world. Boy, was I raw. Like many of my peers, I got married during medical school, and like every surgeon back in those days I told my wife, …
A surgeon will always have two spouses
Recently, I had the honor and pleasure of introducing my book, Women and Cardiovascular Disease, in London. During the event, I was able to meet with many of my European colleagues from both the media as well as the health care space. I spoke with countless bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women. We identified many ways …
What does it take to collaborate in health care? Here are 3 ideas.
For 25 years, I have taught medical students how to give bad news. Step one: Be prepared. Step two: Find a safe, personal, quiet environment. Step three, and this is most important: Before you speak, ask. What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind. So, therefore, you might ask, if I have such wisdom and experience in this critical area …
I broke my own rule when giving bad news
I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I …
Ease the transition to hospital medicine
Every so often I see a patient who views cancer as a constant threat to be handled. The cancer becomes so significant that she feels she can never let her guard down. I always worry about this — partly because that singular focus on fighting cancer can sometimes detract one from other aspects of life, and those facets that give …
When you can’t let your guard down: Cancer as a constant threat
At the end of one of my earlier rotations where I first worked with a team consisting of residents and an attending physician, I sat down with the senior resident for feedback. Much of our final grade for each rotation in medical school comes from a subjective assessment of our abilities, ranging from clinical competence to professionalism.
She told me I had done a good job with taking ownership of my …
Leadership on a medical rotation: The dichotomy of accountability
It’s 2015, and we’re talking about measles. Not Enterovirus. Not Ebola. Not RSV. Not influenza. Instead, we’re talking about a historical virus that was declared eradicated from the United States in 2000. Most pediatricians who began practicing within the last 15 years have never even seen the disease.
Measles starts as a high fever followed by a cough, runny nose (coryza), red and watery eyes (conjunctivitis), and tiny white spots inside the mouth …
With vaccines, pediatricians walk a thin line
As a physician, you have endured many years of schooling, and you have received many A’s on your report cards. You have passed exams with flying colors, and you have pleased your higher-ups in the food chain. You have come so far, and you now find yourself in a rarefied position that most people only dream about.
So what’s standing …
Doctors: Is it time to love the F word?
When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA’s originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that …
Providing health care to the poor: It’s time to get creative
Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively …
The transition to value-based care: Think Starbucks
American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time.
In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is …
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Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient …
It’s time to think about how we’re affecting patient morale
The ink hadn’t yet dried on the report of the 2015 Dietary Guidelines Advisory Committee before the assaults began. I guess in this day and age, that’s not much of a big, fat surprise.
Despite all the over-heated rhetoric I’ve seen about not trusting this report because the “government” can’t be trusted, this report is not from the government. While we may, indeed, need to worry about what the political authorities will …
No, it’s not the broccoli: What to make of the new dietary guidelines
One of the cornerstones of the practice of medicine is finding imperfection in things. When the doctor encounters the patient, the latter expects the former to find out what is “wrong.” In fact, I often see a patient and find nothing wrong, and when I voice this out loud the parents often ask, “Are you sure?”
I completed medical school over 7 and a half years ago. During that time I’ve …
Don’t forget to seek out the beauty in your life
We want to make sure that we stop it before it starts. It’s so much easier to prevent bad medicine than it is to stop it after it’s started.
– Arkansas Rep. Julie Mayberry (R-East End) speaking on Arkansas Public Radio about SB-53, a bill that restricts medical abortions by preventing them via telemedicine — an unfortunate development for the 78 percent of Arkansas women who don’t …
Say no to meddling in medicine
A 75-year-old woman with progressive constipation. An 82-year-old man with unexplained anemia. A 39-year-old mother of two with intermittent blood in her stool. These are three of my patients. And sadly, they are three of nearly 150,000 Americans diagnosed with colorectal cancer every year.
March is National Colorectal Cancer Awareness Month for good reason. In the United States, colorectal cancer is the third most commonly diagnosed cancer. It is also the …
March for colorectal cancer awareness
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
The health care landscape is changing, and now more than ever we as physicians should be focused on quality of care and ensuring the safety of our patients. Anesthesiology was the first medical specialty to champion patient safety as a specific focus. Over the past century, physician …
An informed patient is a safer patient
I remember one day a few years ago when I was talking with one of my friends about the challenges of being a doctor after a tough day at work. I had seen a large number of patients within the span of a few hours, and in addition to many of them being sick, I dealt with family members who had so many questions and who wanted to provide me …
Medicine: A profession of sacred trust
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